Maternal and Perinatal Morbidity and Mortality
Review Committee
Ministry of Health and Family
SBAR Clinical report on
Maternity situation
SITUATION
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I am calling about (name of women)………………………………….Ward………………………Hosp. No
The problem I am calling about is
I just made an assessment of the patient:
Vital signs: BP………… / Pulse………………..rep. rate…………….oxygen saturation…..% oxygen at……./min
temperature………….C
I am concerned about
Blood Pressure because:
Urine output:
Systolic pressure greater than 160mmHg
- output less than 100ml over last 4 hrs
Diastolic pressure more than 100mmHg
- Significant protein uria (+++/++++)
Systolic pressure less than 90mmHg
Haemorrhage
Pulse because:
- Antepartum
Pulse rare more than 120
- Postpartum
Pulse rate less than 40
Fetal well being
Pulse rate greater than systolic BP
- Fetal heart rate
Respiration rate because:
- Fetal movement
Rate less than 10/min
- NST
Rate more than 30/min
BACKGROUND (tick relevant sections)
The women is:
Parity (primiparous / multiparous / granmultiparous) with gestation……..weeks & a (singleton/ multiple pregnancy)
The present fetal assessment is:
Fundal height……wk/cm Presentation……….with……..fiths above brim: Fetal heart rate……..bron
Antenatal risks
Risk identified on antenatal card / period………………………………
Labour
Not in labour / spontaneous onset of labour/induced labour
IUGR/ Pre-eclampsia/reduced fetal movements / Diabetes / Antepartum haemorrhage
On sysntocinon infusion(……..IU/…………….ml fluid given at……………….ml / hour)
Most recent vaginal examination done at………………..h. Dialated……………cm with effacement……………% at saturation
Membranes: Intact / ruptured at………..h with currently clear /meconium stained liquor /blood stained liquor
rd
Delivered…………………..at………………h with 3 stage complete / retained placenta
Post natal
Delivery date………………at…………….h………………type of delivery…………….with/without perineal trauma
Blood loss………………..ml Syntocinon infusion………………IU/…………………ml at……………..ml/hour
Fundal height: High/ Atonic/ Tender/ Abdominal- perineal wound oozing
Treatment given / in progress
Rx…………………………………………………………………………………………………………………………………………………………………..
ASSESMENT
I think the problem is…………………………………………………………………………………………………………………………………….
The problem may be related to: Cardiac/ infection/ respiratory/hemorrhage/PET/HELP/Embolism/Plum
oedema/Fetal distress
I am not sure what the problem is, but the woman is deteriorating and we need to do something
RECOMMENDATION
Request
I think delivery need to be expedited
I think the patient need to be transferred
I would like advice on management of the patient
Response
……………………………………………………………………………………………………………………………………………………………..
Person completing form(Name)…………………………………….Designation………………………………..Date……………………Time…………………Signature
Person reported to (Name)…………………………………….
Designation………………………………Institution…………………..
NB! After completing and consultation, place this form in the patient file as proof of communication and response
IGMH contact numbers:
331 5502
7874298